This inspection took place on 12 January 2017 and was unannounced. At our last inspection in December 2015 we found that the provider ‘required improvement’ in two questions, namely safe and well-led and was found to be ‘good’ the remaining three questions effective, caring and responsive.

Karam Court Care Home provides accommodation and personal care for up to 47 people with a range of conditions related to old age which may include dementia. There were 41 people living at the service at the time of our inspection.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People were supported by staff who were aware of their responsibilities when it came to keeping people safe from harm. Where safeguarding concerns had been raised they had been responded to and acted upon appropriately. Staff were aware of the risks to people on a daily basis and how to manage those risks.

Staffing levels were regularly assessed and staff deployed across the home to ensure people’s care needs were effectively met. Systems were in place to ensure people received their medication safely and effectively.

Staff were provided with induction and training which ensured they had the knowledge and skills they required to carry out their roles and responsibilities. People’s human rights were respected by staff because staff applied the principles of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards in their work practice.

People were supported to have sufficient to eat and drink and maintain a healthy diet. People were offered choices at mealtimes and where assistance with eating their meals was required; this was done discreetly and respectfully. People were supported to access healthcare services in a timely manner to ensure their healthcare needs were met.

People had warm, positive relationships with staff who they described as ‘kind’ and ‘caring’. People felt listened to and were supported to make their own decisions about their care, treatment and support. People’s privacy was respected and they were treated with dignity and respect.

Systems were in place to ensure people received personalised care that was responsive to their needs. Staff were aware of what was important to people, their likes and dislikes and how to respond to them appropriately if they became distressed or upset.

There were a variety of activities taking place for people to enjoy and participate in and people were encouraged to provide feedback on the quality of the service provided. Where complaints had been received, they were investigated in line with the home’s complaints procedure and where appropriate, lessons were learnt.

People considered the service to be well led and were complimentary of the registered manager and the staff group as a whole. The registered manager had a clear vision for the service and the staff group were clearly on board with this. Staff were motivated and enjoyed their work.

Audits were being used to identify areas for improvement across the service and the registered manager continually strived to improve her learning for the benefit of the people living at the home.

We carried out an unannounced comprehensive inspection of this service on 14 December 2015. A breach of legal requirements was found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach in Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Karam Court Care Home on our website at www.cqc.org.uk.

Karam Court is registered to provide accommodation and personal care for a maximum of 47 people. People living there have a range of conditions related to old age which may include dementia. On the day of our inspection 44 people lived at the home.

There was a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Improvements had been made in relation to how medicines were managed and administered to people.

Staff competency checks were in place to ensure staff were administered medication safely.

Staff had received medicine management training and were given the opportunity to discuss medicines issues in team meetings.

Protocols for 'as required' medication were now in place but had not been placed with MAR [Medication Administration Records] charts.

More improvements were required in relation to the preparation and administration of medicines given to people. A daily record of stock balances was in place for each person's medicines, but staff did not always pass on information for further investigation when medicines had not been administered.

This unannounced inspection took place on 14 December 2015. At our last inspection in November 2014, we found that the provider was not meeting one of the regulations associated with the Health and Social Care Act 2008 which related to consent to care and treatment. Following the inspection we asked the provider to take action and make improvements. The provider sent us an action plan outlining the actions they had taken to make the improvements. During this inspection we looked to see if these improvements had been made and found that they had.

Karam Court is registered to provide accommodation and personal care for a maximum of 47 people. People living there have a range of conditions related to old age which may include dementia. On the day of our inspection 44 people lived at the home.

There was a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People living at the home told us that they felt safe and they were supported by staff who knew them well. Staff had receiving training on how to recognise different types of abuse and were confident that if they raised any concerns, appropriate action would be taken.

People were at risk of not receiving their medication on time as medication audits had highlighted a number of gaps in recordings and no action was taken in respect of this. There was a lack of written protocols to inform staff on when to administer particular medication.

Staff felt well trained to do their job and supported by the registered manager. Staff spoke positively about the training and support they received and their induction process.

Staff obtained consent from people before they provided their care. Staff had a good understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and what this meant for people living at the home.

People were supported to eat and drink enough to keep them healthy and were offered choices at mealtimes. Staff were aware of people’s individual dietary needs. People were supported to access a variety of healthcare professionals to ensure their health care needs were met.

People told us the staff in the home were kind and caring. Relatives told us they found the registered manager and staff group to be supportive and approachable.

Staff were aware of people’s likes and dislikes and what was important to them. They were aware of how to respond to people, what interested them and influenced their behaviour. There were a number of activities planned for people to be involved in on a daily basis.

People living at the home, their relatives and staff alike all thought the home was well led and spoke positively about the registered manager and staff group.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

On the day of our inspection 47 people lived at the home. We spoke with six people who lived there and seven of their relatives. We spoke with an external trainer, four members of staff, the registered manager and the area manager. Several people who lived there were unable to verbally tell us their experiences, so we spent time observing how staff interacted with people.

At our last inspection in December 2012 we found that improvements were needed in a number of areas and we set compliance actions in our report for improvements to be made. At this inspection we saw that overall improvements had been made in all of the areas previously identified .

People were encouraged to eat a healthy and nutritious diet. People told us that they had a choice of what to eat and liked the food provided. One person said, "We get a variety of choice on food and staff know what I like to eat."

We saw that there were enough staff employed to meet people's needs and ensure their safety.

We found that appropriate records were in place that had accurate information which fully reflected people's care needs and was accessible to staff when needed.

On the day of our inspection 47 people lived at the home. We spoke with the manager, five people who lived there, four of their relatives, three members of staff and three external health care professionals who had visited the home.

We found that people were treated with respect and dignity. One person said, "I’m happy here, staff are very friendly and treat us with respect.”

We found that care and support was planned and delivered in a way that was intended to ensure people's safety and welfare. One person told us, "I always feel safe, staff look after us very well."

We saw that systems were in place to respond to any allegations of abuse so that people were protected from the risk of harm.

We found that the provider had systems in place to support staff to enable them to provide care and support that meet people's needs and keep them safe.

We found that people were asked for their views about the home and people were listened to. The provider had a robust system in place to ensure the quality of service provision was monitored so that any necessary improvements could be made.

This inspection was part of a themed inspection programme to assess whether older people living in care homes were treated with dignity and respect and whether their nutritional needs were met. The inspection team was led by a CQC inspector who was joined by a second inspector, a practising professional with a medical background and an expert by experience; people who have experience of using services and who can provide that perspective.

To help us understand people's experiences we used the Short Observational

Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experiences of people who could not talk with us.

We spoke with six people living at the home about their care but most people were not able to tell us about their care due to their level of dementia. We used the SOFI tool to observe the care people received at lunchtime alongside general observations during the day. We also spoke to a relative who was visiting the home at the time of our visit who told us that they were very happy with the care being given at the home.

People told us and we saw that their privacy was maintained when they were assisted with personal care tasks and people were spoken to in a respectful way by staff. However, there were occasions during our visit when people’s concerns were not listened to and acted on appropriately. This resulted in people becoming angry and upset and their needs not being adequately met.

People’s planned care was based on their needs and preferences identified by people and their relatives during the assessment process. People were enabled to make choices about where they sat, the activities they were involved in and what they ate and drank. People told us they were happy with the care they received but we saw some examples of staff not meeting people’s needs adequately.

We saw that although some people enjoyed their meals lunch time was rushed and support offered to people was not well organised and for some people the lunchtime experience was not an enjoyable one. One person said, “Staff are happy to provide additional drinks and biscuits if requested”. The amount of food and drink people at risk of poor nutrition were having was not always easy to monitor because records were not detailed enough.

People told us they were able to raise concerns and felt sure that they would be listened to. We saw that staff had been provided with training to ensure that they had the knowledge and skills to keep people safe from harm. We saw that staff did not always know how to respond appropriately to people’s emotional needs and did not always follow safe moving and handling practices putting people at risk of harm.

Records were stored safely but the records were not detailed enough to ensure that people received personalised care and to ensure that they received adequate food and hydration.

Karam Court is registered to provide accommodation and personal care for a maximum of 47 people. People living there have a range of conditions related to old age which may include dementia. On the day of our inspection 46 people lived at the home.

The inspection was unannounced and was carried out over two days on 12 and 13 November 2014. A manager was registered with us as required by law. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have the legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We last inspected Karam Court in March 2014. At that inspection we found the provider was meeting all the essential standards we assessed.

The principles of the Mental Capacity Act 2005 had not always been followed when important decisions needed to be made in people’s best interest for example in relation to health care matters. We identified a breach in the law concerning this. You can see what action we told the provider to take at the back of the full version of this report. The manager had followed the requirements of the Deprivation of Liberty Safeguards (DoLS). This is a legal framework that may need to be applied to people in care settings who lack capacity and may need to be deprived of their liberty in their own best interest to protect them from harm or injury.

People told us that they felt safe living at the home. There were systems in place to minimise the risk of abuse. Staff we spoke with understood that they had responsibility to take action to protect people from harm.

People told us that staff were caring and kind and they told us that they felt safe with staff.

During our inspection we saw many positive interactions between staff and people that lived at the home.

People told us that they received their medication on time and in a way that they wanted. Arrangements in place ensured that medication was stored safely.

Staff knew about people’s needs. Staff received the appropriate training to enable them to deliver care safely and effectively.

People told us they liked the food. We saw that drinks and food was available throughout the day. If people needed staff support to help them eat, this was provided.

We saw that people were supported to take part in individual hobbies and interests.

Arrangements were in place so that the manager responded to people’s complaints and took action to improve the service.

There were systems in place for monitoring the service. However, they had not always been timely and effective to identify where some improvements were needed.